Il trattamento della malattia da reflusso gastroesofageo senza lesioni mucosali

Gastroesophageal reflux disease (GERD) represents an important public health problem owing to its remarkable diffusion in the general population. It is estimated that 58.7% of the general population in the USA complain of gastroesophageal reflux disorders during the course of each year. Diagnosis can be suggested by typical symptoms, but only endoscopic examination makes it possible to differentiate between GERD without mucosal lesions from esophagitis itself. Changes in diet and lifestyle are suggested for esophageal reflux without mucosal lesions as well as drug therapy: antacids and alginates, prokinetics, H2 receptor antagonists, proton pump inhibitors (PPIs). The recent availability of soluble as opposed to traditional formulations of cimetidine, famotidine and ranitidine have especially given rise to interest with their capacity of higher speed of absorption with quicker antisecretory action compared to omeprazole or lansoprazole, at least in the first hours after administration. These pharmacological properties mean quicker control of GERD symptoms in a high percentage of patients (82- 92%). PPIs are confirmed as very effective drugs. Even in the absence of mucosal lesions, they have proved significantly superior analgesic activity compared to gastrokinetics and H2 receptors antagonists, when efficacy is evaluated after 4 weeks of therapy.